{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:02:56Z","timestamp":1762506176542,"version":"3.32.0"},"reference-count":60,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Hyperventilation is known to decrease cerebral blood flow (CBF) and to impair cerebral metabolism, but the threshold in patients undergoing intravenous anesthesia is unknown. The authors hypothesized that reduced CBF associated with moderate hyperventilation might impair cerebral aerobic metabolism in patients undergoing intravenous anesthesia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Thirty male patients scheduled for coronary surgery were included in a prospective, controlled crossover trial. Measurements were performed under fentanyl-midazolam anesthesia in a randomized sequence aiming at partial pressures of carbon dioxide of 30 and 50 mmHg. Endpoints were CBF, blood flow velocity in the middle cerebral artery, and cerebral metabolic rates for oxygen, glucose, and lactate. Global CBF was measured using a modified Kety\u2013Schmidt technique with argon as inert gas tracer. CBF velocity of the middle cerebral artery was recorded by transcranial Doppler sonography. Data were presented as mean (SD). Two-sided paired <jats:italic toggle=\"yes\">t<\/jats:italic> tests and one-way ANOVA for repeated measures were used for statistical analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Moderate hyperventilation significantly decreased CBF by 60%, blood flow velocity by 41%, cerebral oxygen delivery by 58%, and partial pressure of oxygen of the jugular venous bulb by 45%. Cerebral metabolic rates for oxygen and glucose remained unchanged; however, net cerebral lactate efflux significantly increased from \u22120.38 (2.18) to \u22122.41(2.43) \u00b5mol min<jats:sup>\u22121<\/jats:sup> 100 g<jats:sup>\u22121<\/jats:sup>.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Moderate hyperventilation, when compared with moderate hypoventilation, in patients with cardiovascular disease undergoing intravenous anesthesia increased net cerebral lactate efflux and markedly reduced CBF and partial pressure of oxygen of the jugular venous bulb, suggesting partial impairment of cerebral aerobic metabolism at clinically relevant levels of hypocapnia.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/aln.0b013e3182a8eb09","type":"journal-article","created":{"date-parts":[[2013,8,27]],"date-time":"2013-08-27T09:27:46Z","timestamp":1377595666000},"page":"335-342","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":15,"title":["Moderate Hyperventilation during Intravenous Anesthesia Increases Net Cerebral Lactate Efflux"],"prefix":"10.1097","volume":"120","author":[{"given":"Frank","family":"Gr\u00fcne","sequence":"first","affiliation":[{"name":"From the Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands (F.G., R.J.S.); Department of Anesthesiology, Critical Care, and Emergency Medicine, University of G\u00f6ttingen, G\u00f6ttingen, Germany (S.K., H.S.); and Department of Anesthesiology, Critical Care, Emergency, and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany (A.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Kazmaier","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands (F.G., R.J.S.); Department of Anesthesiology, Critical Care, and Emergency Medicine, University of G\u00f6ttingen, G\u00f6ttingen, Germany (S.K., H.S.); and Department of Anesthesiology, Critical Care, Emergency, and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany (A.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Sonntag","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands (F.G., R.J.S.); Department of Anesthesiology, Critical Care, and Emergency Medicine, University of G\u00f6ttingen, G\u00f6ttingen, Germany (S.K., H.S.); and Department of Anesthesiology, Critical Care, Emergency, and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany (A.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert Jan","family":"Stolker","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands (F.G., R.J.S.); Department of Anesthesiology, Critical Care, and Emergency Medicine, University of G\u00f6ttingen, G\u00f6ttingen, Germany (S.K., H.S.); and Department of Anesthesiology, Critical Care, Emergency, and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany (A.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Weyland","sequence":"additional","affiliation":[{"name":"From the Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands (F.G., R.J.S.); Department of Anesthesiology, Critical Care, and Emergency Medicine, University of G\u00f6ttingen, G\u00f6ttingen, Germany (S.K., H.S.); and Department of Anesthesiology, Critical Care, Emergency, and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany (A.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20241219","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1097\/00000542-199805000-00029","article-title":"Carbon dioxide and the cerebral circulation.","volume":"88","year":"1998","journal-title":"Anesthesiology"},{"key":"R2-20241219","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1097\/EJA.0b013e32833cca07","article-title":"Intraoperative carbon dioxide management and outcomes.","volume":"27","year":"2010","journal-title":"Eur J Anaesthesiol"},{"key":"R3-20241219","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/j.1749-6632.1997.tb48479.x","article-title":"Misery perfusion with preserved vascular reactivity in Alzheimer\u2019s disease.","volume":"826","year":"1997","journal-title":"Ann N Y Acad Sci"},{"key":"R4-20241219","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1161\/01.CIR.37.6.1036","article-title":"Cerebral oxygen, glucose, lactate, and pyruvate metabolism in stroke. Therapeutic considerations.","volume":"37","year":"1968","journal-title":"Circulation"},{"key":"R5-20241219","doi-asserted-by":"crossref","first-page":"222","DOI":"10.3171\/jns.1989.70.2.0222","article-title":"Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients.","volume":"70","year":"1989","journal-title":"J Neurosurg"},{"key":"R6-20241219","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/00000542-200203000-00014","article-title":"Relationship between intracranial pressure and critical closing pressure in patients with neurotrauma.","volume":"96","year":"2002","journal-title":"Anesthesiology"},{"key":"R7-20241219","doi-asserted-by":"crossref","first-page":"1950","DOI":"10.1097\/00003246-200209000-00002","article-title":"Effect of hyperventilation on cerebral blood flow in traumatic head injury: Clinical relevance and monitoring correlates.","volume":"30","year":"2002","journal-title":"Crit Care Med"},{"key":"R8-20241219","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1034\/j.1399-6576.2002.460515.x","article-title":"Cerebral blood flow, oxidative metabolism and cerebrovascular carbon dioxide reactivity in patients with acute bacterial meningitis.","volume":"46","year":"2002","journal-title":"Acta Anaesthesiol Scand"},{"key":"R9-20241219","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.brainres.2004.05.099","article-title":"Influence of moderate and profound hyperventilation on cerebral blood flow, oxygenation and metabolism.","volume":"1019","year":"2004","journal-title":"Brain Res"},{"key":"R10-20241219","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1002\/mrm.1910100204","article-title":"1H and 31P NMR measurement of cerebral lactate, high-energy phosphate levels, and pH in humans during voluntary hyperventilation: Associated EEG, capnographic, and Doppler findings.","volume":"10","year":"1989","journal-title":"Magn Reson Med"},{"key":"R11-20241219","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1038\/sj.jcbfm.9600383","article-title":"Brain changes to hypocapnia using rapidly interleaved phosphorus-proton magnetic resonance spectroscopy at 4 T.","volume":"27","year":"2007","journal-title":"J Cereb Blood Flow Metab"},{"key":"R12-20241219","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/j.1365-2044.1989.tb11284.x","article-title":"Cerebral effects of anaesthesia and hypothermia.","volume":"44","year":"1989","journal-title":"Anaesthesia"},{"key":"R13-20241219","first-page":"153","article-title":"[The effect of sufentanil on cerebral blood flow, cerebral metabolism and the CO2 reactivity of the cerebral vessels in man].","volume":"40","year":"1991","journal-title":"Anaesthesist"},{"key":"R14-20241219","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1097\/00000542-199412000-00015","article-title":"Flow velocity measurements as an index of cerebral blood flow.","volume":"81","year":"1994","journal-title":"Anesthesiology"},{"key":"R15-20241219","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/00000542-196403000-00013","article-title":"Cerebral carbohydrate metabolism in man during halothane anesthesia: Effects of PaCO2 on some aspects of carbohydrate utilization.","volume":"25","year":"1964","journal-title":"Anesthesiology"},{"key":"R16-20241219","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1152\/jappl.1968.24.1.66","article-title":"Cerebral carbohydrate metabolism of man during respiratory and etabolic alkalosis.","volume":"24","year":"1968","journal-title":"J Appl Physiol"},{"key":"R17-20241219","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1093\/bja\/81.2.155","article-title":"Effects of 1 MAC desflurane on cerebral metabolism, blood flow and carbon dioxide reactivity in humans.","volume":"81","year":"1998","journal-title":"Br J Anaesth"},{"key":"R18-20241219","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1213\/00000539-199908000-00022","article-title":"Effects of one minimum alveolar anesthetic concentration sevoflurane on cerebral metabolism, blood flow, and CO2 reactivity in cardiac patients.","volume":"89","year":"1999","journal-title":"Anesth Analg"},{"key":"R19-20241219","first-page":"322","article-title":"[Measurement of the coronary blood flow with argon-foreign gas method in the patient].","volume":"58","year":"1969","journal-title":"Basic Res Cardiol"},{"key":"R20-20241219","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1152\/jappl.1979.46.6.1169","article-title":"Solubility and partition coefficients for gases in rabbit brain and blood.","volume":"46","year":"1979","journal-title":"J Appl Physiol"},{"key":"R21-20241219","first-page":"64","article-title":"Effect of ketanserin on global cerebral blood flow and middle cerebral artery flow velocity.","volume":"80","year":"1995","journal-title":"Anesth Analg"},{"key":"R22-20241219","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/00008506-200007000-00002","article-title":"Cerebrovascular tone rather than intracranial pressure determines the effective downstream pressure of the cerebral circulation in the absence of intracranial hypertension.","volume":"12","year":"2000","journal-title":"J Neurosurg Anesthesiol"},{"key":"R24-20241219","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1161\/01.STR.21.11.1573","article-title":"Effect of emitted power on waveform intensity in transcranial Doppler.","volume":"21","year":"1990","journal-title":"Stroke"},{"key":"R25-20241219","doi-asserted-by":"crossref","first-page":"597","DOI":"10.3171\/jns.1974.41.5.0597","article-title":"Experimental cerebral hemodynamics. Vasomotor tone, critical closing pressure, and vascular bed resistance.","volume":"41","year":"1974","journal-title":"J Neurosurg"},{"key":"R26-20241219","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1053\/jlts.2001.23075","article-title":"Transcranial Doppler sonography and internal jugular bulb saturation during hyperventilation in patients with fulminant hepatic failure.","volume":"7","year":"2001","journal-title":"Liver Transpl"},{"key":"R28-20241219","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1001\/archpediatrics.2011.97","article-title":"Arguments for and against standardized mean differences (effect sizes).","volume":"165","year":"2011","journal-title":"Arch Pediatr Adolesc Med"},{"key":"R29-20241219","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.","volume":"41","year":"2009","journal-title":"Behav Res Methods"},{"key":"R30-20241219","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1111\/j.1471-4159.1973.tb07582.x","article-title":"The influence of hypocapnia upon intracellular pH and upon some carbohydrate substrates, amino acids and organic phosphates in the brain.","volume":"21","year":"1973","journal-title":"J Neurochem"},{"key":"R31-20241219","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1007\/BF00592288","article-title":"Effects of carbon dioxide, bicarbonate and pH on lactate and pyruvate in the brain of rats.","volume":"314","year":"1970","journal-title":"Pflugers Arch"},{"key":"R32-20241219","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1097\/00003246-199109000-00005","article-title":"Lactic acid kinetics in respiratory alkalosis.","volume":"19","year":"1991","journal-title":"Crit Care Med"},{"key":"R33-20241219","first-page":"247","article-title":"[On the effects of hexobarbituric acid on oxygen consumption and vulnerability of the brain].","volume":"272","year":"1961","journal-title":"Pflugers Arch Gesamte Physiol Menschen Tiere"},{"key":"R34-20241219","first-page":"114","article-title":"Cerebral effects of hyperventilation.","volume":"45","year":"1971","journal-title":"Acta Anaesthesiol Scand Suppl"},{"key":"R35-20241219","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/BF00596170","article-title":"Effects of severe arterial hypocapnia on regional blood flow regulation, tissue PO2 and metabolism in the brain cortex of cats.","volume":"391","year":"1981","journal-title":"Pflugers Arch"},{"key":"R36-20241219","first-page":"407","article-title":"Hyperventilation-induced cerebral hypoxia.","volume":"122","year":"1980","journal-title":"Am Rev Respir Dis"},{"key":"R37-20241219","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/1522-2594(200101)45:1<61::AID-MRM1010>3.0.CO;2-8","article-title":"Effect of hyperoxia, hypercapnia, and hypoxia on cerebral interstitial oxygen tension and cerebral blood flow.","volume":"45","year":"2001","journal-title":"Magn Reson Med"},{"key":"R38-20241219","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1038\/jcbfm.2009.35","article-title":"Blood lactate is an important energy source for the human brain.","volume":"29","year":"2009","journal-title":"J Cereb Blood Flow Metab"},{"key":"R39-20241219","doi-asserted-by":"crossref","first-page":"4768","DOI":"10.1523\/JNEUROSCI.6612-10.2011","article-title":"Lactate transport and metabolism in the human brain: Implications for the astrocyte-neuron lactate shuttle hypothesis.","volume":"31","year":"2011","journal-title":"J Neurosci"},{"key":"R40-20241219","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.pneurobio.2011.09.008","article-title":"Sympathetic influence on cerebral blood flow and metabolism during exercise in humans.","volume":"95","year":"2011","journal-title":"Prog Neurobiol"},{"key":"R41-20241219","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/S0021-9258(18)72512-X","article-title":"Arterial and cerebral venous blood: Arterial-venous differences in man.","volume":"144","year":"1942","journal-title":"J Biol Chem"},{"key":"R42-20241219","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/j.1475-097X.2009.00889.x","article-title":"Maintained cerebral metabolic ratio during exercise in patients with beta-adrenergic blockade.","volume":"29","year":"2009","journal-title":"Clin Physiol Funct Imaging"},{"key":"R43-20241219","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1152\/jappl.1998.85.2.554","article-title":"A model for the regulation of cerebral oxygen delivery.","volume":"85","year":"1998","journal-title":"J Appl Physiol"},{"key":"R44-20241219","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/00004647-200003000-00007","article-title":"Dependence of oxygen delivery on blood flow in rat brain: A 7 tesla nuclear magnetic resonance study.","volume":"20","year":"2000","journal-title":"J Cereb Blood Flow Metab"},{"key":"R45-20241219","first-page":"H209","article-title":"Effects of changes in arterial O2 content on cerebral blood flow in the lamb.","volume":"240","year":"1981","journal-title":"Am J Physiol"},{"key":"R46-20241219","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/00000542-198709000-00010","article-title":"Isoflurane when compared to enflurane and halothane decreases the frequency of cerebral ischemia during carotid endarterectomy.","volume":"67","year":"1987","journal-title":"Anesthesiology"},{"key":"R47-20241219","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/978-0-387-71764-7_23","article-title":"Normal cardiac output, oxygen delivery and oxygen extraction.","volume":"599","year":"2007","journal-title":"Adv Exp Med Biol"},{"key":"R48-20241219","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1097\/00004647-200206000-00012","article-title":"Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: A combined microdialysis and triple oxygen positron emission tomography study.","volume":"22","year":"2002","journal-title":"J Cereb Blood Flow Metab"},{"key":"R49-20241219","doi-asserted-by":"crossref","first-page":"3977","DOI":"10.1529\/biophysj.107.126094","article-title":"In vivo mitochondrial oxygen tension measured by a delayed fluorescence lifetime technique.","volume":"95","year":"2008","journal-title":"Biophys J"},{"key":"R50-20241219","doi-asserted-by":"crossref","first-page":"H11","DOI":"10.1152\/ajpheart.01293.2007","article-title":"Quantifying the role of oxygen pressure in tissue function.","volume":"294","year":"2008","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"R51-20241219","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/j.1440-1681.2011.05573.x","article-title":"Hyperbaric oxygen preconditioning: What remains between hypoxia and hyperoxia?","volume":"38","year":"2011","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"R52-20241219","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1093\/bja\/47.9.941","article-title":"The effect of carbon dioxide on cerebral blood flow and cerebral metabolism in dogs.","volume":"47","year":"1975","journal-title":"Br J Anaesth"},{"key":"R53-20241219","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/00003643-200110000-00003","article-title":"Reliability of cerebral blood flow measurements by transcerebral double-indicator dilution technique.","volume":"18","year":"2001","journal-title":"Eur J Anaesthesiol"},{"key":"R54-20241219","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1161\/01.STR.18.3.649","article-title":"Cerebral effects of extended hyperventilation in unanesthetized goats.","volume":"18","year":"1987","journal-title":"Stroke"},{"key":"R55-20241219","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/00000542-200002000-00017","article-title":"Bedside assessment of cerebral blood flow by double-indicator dilution technique.","volume":"92","year":"2000","journal-title":"Anesthesiology"},{"key":"R56-20241219","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1097\/00000542-198709000-00006","article-title":"Cerebral vascular and metabolic effects of fentanyl and midazolam in young and aged rats.","volume":"67","year":"1987","journal-title":"Anesthesiology"},{"key":"R57-20241219","first-page":"847","article-title":"Noninvasive estimation of cerebral perfusion pressure and zero flow pressure in healthy volunteers: The effects of changes in end-tidal carbon dioxide.","volume":"96","year":"2003","journal-title":"Anesth Analg"},{"key":"R58-20241219","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1213\/ane.0b013e318196728e","article-title":"The effects of hypocapnia and the cerebral autoregulatory response on cerebrovascular resistance and apparent zero flow pressure during isoflurane anesthesia.","volume":"108","year":"2009","journal-title":"Anesth Analg"},{"key":"R59-20241219","first-page":"871","article-title":"[Methods of measuring the blood supply of an organ using argon].","volume":"60","year":"1971","journal-title":"Z Kreislaufforsch"},{"key":"R60-20241219","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1038\/jcbfm.1985.48","article-title":"Normal average value of cerebral blood flow in younger adults is 50 ml\/100 g\/min.","volume":"5","year":"1985","journal-title":"J Cereb Blood Flow Metab"},{"key":"R61-20241219","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1152\/jappl.1993.74.1.245","article-title":"Middle cerebral artery blood velocity and cerebral blood flow and O2 uptake during dynamic exercise.","volume":"74","year":"1993","journal-title":"J Appl Physiol"},{"key":"R62-20241219","first-page":"1146","article-title":"The relationship between cerebral blood flow and transcranial Doppler blood flow velocity during hypothermic cardiopulmonary bypass in adults.","volume":"82","year":"1996","journal-title":"Anesth Analg"}],"container-title":["Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/pubs.asahq.org\/anesthesiology\/article-pdf\/120\/2\/335\/484523\/20140200_0-00020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/anesthesiology.pubs.asahq.org\/article.aspx?volume=120&page=335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T13:54:53Z","timestamp":1735912493000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/ALN.0b013e3182a8eb09"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":60,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014]]}},"URL":"https:\/\/doi.org\/10.1097\/aln.0b013e3182a8eb09","relation":{},"ISSN":["0003-3022"],"issn-type":[{"type":"print","value":"0003-3022"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}